Escolar Documentos
Profissional Documentos
Cultura Documentos
Psychiat.
(1979),
135,97103
SCHOU
SUMMARY
Twenty-four
manic-depressive
artists, in whom prophy
lactic lithium treatment had attenuated or prevented recurrences
to a
significant
degree, were questioned
about their creative power during
the treatment.
Twelve artists reported increased artistic productivity,
six unaltered productivity,
and six lowered productivity.
The effect of
lithium treatment on artistic productivity
may depend on the severity
and type of the illness, on individual
sensitivity,
and on habits of
utilizing manic episodes productively.
emotional
and intellectual
experiences
which
contribute
to the ability to create.
The present study was undertaken
to provide
data bearing on these questions
and to guide
psychiatrists
and creative
patients
who are
faced with the decision: lithium treatment
or no
lithium treatment?
When
prophylactic
lithium
treatment
is
contemplated,
patients sometimes
express con
cern along the following lines: My
work is to a
large extent creative.
Is there any risk that
lithium
treatment
may
interfere
with
my
creative
power?
Nerve pills are reported
to
blunt intellectual
and emotional
functions, and
I understand
that lithium
treatment
is often
given for years.
What
will happen
to my
productivity?'
This question cannot be answered in advance
for the individual
patient,
but observations
of
what happened
to other creative persons given
lithium treatment
may reveal response patterns
and trends. When such data are interpreted,
it
should be kept in mind that two factors may be
involved:
(i) the effect of the treatment
on
productivity,
and (ii) the effect of the treatment
effect on productivity.
(i) Long-term
lithium
administration
is in most cases remarkably
free
of mental side effects, but occasionally
patients
complain
of impaired
memory or restriction
of
their emotional
range.
Creative
productivity
may be particularly
sensitive to subtle psycho
logical changes induced by lithium. (ii) Prophy
lactic
lithium
treatment
often
effectively
counteracts
further
episodes
of mania
or
depression
or both. This may be beneficial for
artistic
productivity
because
interruptions
of
work are avoided. It is, however, also possible
that eradication
of the periods of elation and
melancholy
may deprive the creative person of
Method
Creativeness
may be expressed
in many
professions,
by scientists,
inventors,
business
men, administrators,
politicians,
etc. In the
present study I have limited myself to examining
artists, and chiefly those artists whose activity
was primary,
for example
composers,
rather
than secondary,
for example
instrumentalists.
The study includes only artists suffering from
manic-depressive
illness, bipolar
or unipolar,
and only those in whom prophylactic
lithium
treatment
had been successful, i.e. had attenu
ated or prevented
manic and depressive recur
rences to a significant
degree.
Patients
who
stopped
lithium
after a short time because
lithium-induced
tremor
interfered
with their
work have not been included.
Information
was collected from a variety of
sources. I have used my own clinical experience
as well as reports from psychiatrists
in many
countries. Such reports were solicited in personal
conversations
or as a response to requests
in
lectures and articles. I corresponded
with one
artist
(Case No. 21) and interviewed
four
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from getting
out of control'. The patient feels that he has
been more productive,
has painted better pictures, and
has matured
artistically
during the year of consistent
lithium intake.
Case 2. In a 42-year-old male physician and author,
severe bipolar manic-depressive
illness started when the
patient was 20. During prophylactic
lithium treatment
over the last six years the cyclic course has continued, but
episodes have become shorter and much milder.
While on lithium, the patient has never had to interrupt
work as a physician.
His writings have increased
in
volume and also, according to his own opinion and that of
his critics, improved in quality.
Case 3. A 62-year-old male author suffered from the age
of 19 from frequent recurrences of manic-depressive
illness
with moderate depressions and severe manias, the latter
combined with alcohol abuse.
During lithium treatment for 14 years the episodes have
been markedly attenuated,
and the alcohol consumption
has come under control. He has been more stable and
reliable in his work and has been able to adhere to a tight
working schedule, so that his productivity has increased.
Case 4. A 42-year-old
male publisher and amateur
painter
suffered from recurrent
depressions
with in
capacitating
anxiety
and phobias
since adolescence.
Starting to draw and paint gave some relief from anxiety
and was experienced as a joyful means of self-expression.
He became very productive and had a successful exhibition
in spite of being self-taught.
Lithium treatment,
begun two years ago, has been
adhered to punctiliously.
It has led to fewer and less
severe depressions but not to complete stabilization.
The
patient feels that lithium treatment has helped his artistic
productivity by reducing dysphoria and anxiety.
Case 5. A 35-year-old female author suffered since the
age of 16 from severe depressions
and mild manias.
Lithium treatment during the last three years has led to
mood stabilization. There are occasional slight dysphorias.
She started writing at an early age, but the apathy,
bleakness and painfully slow mentation during depressions
interfered seriously with her work. Not till after two years
of lithium treatment did she resume writing. She now feels
full of creative power; she is steady in mood and not
tossed
about' by her affects. Whereas previously her work
tended to be misty
and indistinct', it is now defined
and
informative'.
Only occasionally
does she miss the
manias. Productivity
is regular, and ideas come to her
readily.
Case 6. A 49-year-old
male journalist
and author
developed manic-depressive
illness in his late twenties with
violent manias and prolonged depressions. This interfered
so much with his work as a journalist that he obtained an
invalid pension. Prophylactic
lithium treatment
given
from the age of 36 gave excellent response during the first
five years. Thereafter minor mood swings occurred.
The patient has been active as a journalist and author,
writing both books and film scenarios. Although during
lithium treatment he missed the manic periods of excessive
joy and initiative, he was in no doubt that the treatment
raised his productivity.
Not only did it prevent the
unproductive depressions, but it also saved him from manic
MOGENS SCHOU
valueless overproduction,
which later had to be sifted
carefully in order to retrieve the few pieces of some merit.
During lithium treatment
he was able to return to his
activities as a journalist
because now, in contrast to the
period before lithium, he could keep assignments.
He
died at the age of 49 from a heart attack.
Case 7. In a 37-year-old male teacher and amateur
painter bipolar manic-depressive
illness started four years
ago with moderate depressions and severe manias requir
ing hospitalization.
Lithium treatment for the last three
years has prevented depressions and attenuated
manias
so that they no longer incapacitate the patient socially and
professionally.
During the first year of his mood disorder the patient's
productivity
decreased. Under lithium treatment he has
again become more productive and has changed his style
from realism to more abstract painting. He ascribes his
rise in productivity to stabilization of mood and possibly to
more frequent hypomanic episodes.
Case 8. A 38-year-old
female journalist
and author
suffered from the age of 18 from bipolar manic-depressive
illness with schizo-affective
features;
she had many
hospitalizations
and a number of treatments.
Since the
start of lithium treatment eight years ago the patient has
had one brief mania and one mild depression.
During
lithium
treatment
artistic productivity
has
increased quantitatively,
and she also finds it of better
quality than before her lithium treatment
was started.
Her latest book is considered by the critics to be her best.
Case 9. A 44-year-old male painter had mild manias and
anxious and somewhat agitated depressions from the age
of 21. During lithium treatment over the last two years
there have been no episodes.
Before lithium treatment the depressions interfered with
his artistic work. During the treatment
he has become
more motivated
to undertake
creative activity, and he
works quicker and more freely.
Case 10. A 55-year-old male commercial illustrator and
painter suffered from recurrent depressions since the age
of 30. Lithium administration
for fiveyears led to marked
improvement
with complete
absence
of recurrences
during the last three years of treatment. The patient then
stopped lithium, and depressions reappeared.
After three
years without lithium, treatment was resumed.
The patient's artistic productivity rose markedly during
lithium treatment,
both subjectively and objectively. His
work was much more stable, and he changed from being
a commercial
illustrator
into becoming
a successful
painter.
Case 11. A 44-year-old male theatre producer and author
began suffering from bipolar manic-depressive
illness
twelve years ago. Lithium treatment, started seven years
ago, has completely abolished the manic episodes; brief
periods of slight mood lowering may occur.
Before lithium treatment manic episodes were associated
with restlessness, irritability and an uncontrolled
flow of
not very useful ideas. Depressions were grey, unpleasant
and tiring, and they did not provide material that could
be used artistically.
Lithium treatment
has led to emo
tional stability with more efficient utilization of artistic
abilities. Productivity
has gone up; within the last five
99
years the patient has published four novels and had two
plays performed.
Case 12. A 22-year-old male painter and artist-craftsman
became depressed at the age of 14 and later had a number
of depressions but no manias. Lithium treatment
was
started when he was 16; at first there was poor com
pliance, but gradually the patient became co-operative,
and depressions disappeared.
The patient is an art student, who also paints and works
with ceramics
and collages.
During
depressions
his
productivity
decreased, and colours and shapes changed
in his productions.
Lithium treatment
may have been
helpful to his artistic work by preventing depressions, but
it is difficult to distinguish this effect from that of con
comitant rapid maturation.
He stopped lithium a year ago
and has since then been less creative, possibly because he
now pays more attention to his formal training.
Cases with wzaffectedproductivz@y
Case 13. A 46-year-old male composer suffered from the
100
lithium treatment
the depressions were somewhat ame
liorated. Treatment
was discontinued
at the patient's
request.
The patient asserts that depressions do not interfere
with her artistic productivity.
While she took lithium,
however, she found her creative power diminished,
and
she regards this as a direct drug effect. Later information
from the psychiatrist
reveals that the patient lost her
husband while she was on lithium and that the rise in
productivity
after discontinuation
of treatment was only
transitory.
Case 22. A 63-year-old male author suffered for many
years from recurrent
manic-depressive
illness combined
with alcohol abuse. Lithium maintenance
treatment
for
one year led to disappearance
of manic and depressive
episodes and of the excessive urge to drink.
The patient stopped lithium treatment because he felt
that it held back his creative energy. Nevertheless he wrote
a successful book while on lithium. A second book was
written partly on and partly off lithium, and the author
feels that the parts written after discontinuation
of lithium
are of higher quality than those written under the influence
of the drug.
Case 23. A 58-year-old book-keeper and poet suffered
during the last seven years from clearcut manic episodes
and slight depressions. Lithium treatment during the last
two years has almost abolished recurrences.
The patient has published small books about art history
and writes poems for a weekly magazine. During manic
episodes he wrote many poems a day, but their quality
was not very high. Depressions impaired productivity and
did not give experiences which could be used artistically.
During lithium treatment there is the urge to write, but
ideas do not come as readily as before. The creative power
is returning gradually
but is still not as flourishing as
before treatment started.
Case 24. A 62-year-old female amateur painter suffered
from recurrent manic-depressive
illness for 27 years before
starting lithium treatment
seven years ago. Since then
there have been only slight recurrences,
possibly due to
lack of compliance.
The patient makes painted collages from fish bones and
scales, sea weed, and other natural materials. After the
start of lithium treatment all creative activity stopped for
a year or two. Thereafter
it returned, and although she
may miss the spells of creative urge associated with
manias, her net productivity
is now as before lithium.
The quality has risen. She is more critical of what she
does, and instead of starting many projects simultaneously
in the way she did previously during manic episodes, she
now finishes one thing at a time.
Discussion
MOGENS SCHOU
Marshall
ci al (1970)
reported
about
five
and
of sounder
quality
during
lithium
treatment
(his lithiumperiod').
It is not
101
102
which
form
the
basis
of creativeness.
One
of
directly,
but
additional
factors
been at work.
Studies on healthy
volunteers
value
lithium
possible
direct
It is difficult,
in
elucidating
on creativeness.
may
have
are of limited
effects
of
perhaps
impossible,
to measure
creative
ability
with
objective psychometric
tests. Related cognitive
functions were studied by Judd et al (1977), who
compared
the effects of lithium
and placebo
given for two weeks each to 24 normal subjects.
Neither
the Meyer Art Test, which measures
aesthetic
perception
and art judgement,
nor
the Guilford-Christensen
Fluency Tests, which
assess semantic fluency as a possible measure of
creative
ability, showed significant
differences
between the two treatments.
Analysis of the cases reported in the literature
and in the present study indicates that a number
of
artists
lost
productivity
because
energy
and
ideas.
When
lithium
treat
ment deprived
them of these periods, they felt
their creative power fall to, or even below, the
level they usually experienced
during intervals.
In some
cases
this
was
so intolerable
stopped
ductivity
lithium,
preferring
to health without
that
they
productivity.
It seems conceivable
that also periods
of
melancholy,
dwelling in the land of the shadow
of death,
might
provide
experiences
which
could be used creatively,
if not during
then
perhaps after the depressions.
However, none of
the observations
collected
until now supports
this notion;
on the contrary,
the artists de
scribed
the depressions
as grey, barren,
and
unproductive
of intellectual
and emotional
material
of artistic
The present
Acknowledgements
It is my pleasant duty to thank the psychiatrists who
provided the information and the artists who gave it and
permitted its use in this study.
before
treatment
they had been in the habit of basing
their production
on the manic
episodes
of
surplus
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